Relationship Between Presence of a Reported Medical Home and Emergency Department Use Among Children With Asthma

South Carolina Public Health Consortium, Arnold School of Public Health, University of South Carolina, 800 Sumter Street, Suite 309, Columbia, SC 29208, USA.
Medical Care Research and Review (Impact Factor: 2.57). 05/2010; 67(4):450-75. DOI: 10.1177/1077558710367735
Source: PubMed

ABSTRACT This study examined data from the 2005-2006 National Survey of Children with Special Health Care Needs to assess the relationship among children with asthma between a reported medical home and emergency department (ED) use. The authors used 21 questions to measure 6 medical home components: personal doctor/nurse, family-centered, compassionate, culturally effective and comprehensive care, and effective care coordination. Weighted zero-inflated Poisson regression analyses assessed the independent effects of having a medical home on annual number of child ED visits while controlling for child and parental characteristics, and the differential likelihood of securing a medical home. Nearly half (49.9%) of asthmatic children had a medical home. Receiving primary care in a medical home was associated with fewer ED visits (incidence rate ratio = 0.93; 95% confidence interval = 0.89-0.97). A medical home in which physicians and parents share responsibility for ensuring that children have access to needed services may improve child and family outcomes for children with asthma.

  • [Show abstract] [Hide abstract]
    ABSTRACT: Interventions to transform primary care practices into medical homes are increasingly common, but their effectiveness in improving quality and containing costs is unclear. To measure associations between participation in the Southeastern Pennsylvania Chronic Care Initiative, one of the earliest and largest multipayer medical home pilots conducted in the United States, and changes in the quality, utilization, and costs of care. Thirty-two volunteering primary care practices participated in the pilot (conducted from June 1, 2008, to May 31, 2011). We surveyed pilot practices to compare their structural capabilities at the pilot's beginning and end. Using claims data from 4 participating health plans, we compared changes (in each year, relative to before the intervention) in the quality, utilization, and costs of care delivered to 64,243 patients who were attributed to pilot practices and 55,959 patients attributed to 29 comparison practices (selected for size, specialty, and location similar to pilot practices) using a difference-in-differences design. Pilot practices received disease registries and technical assistance and could earn bonus payments for achieving patient-centered medical home recognition by the National Committee for Quality Assurance (NCQA). Practice structural capabilities; performance on 11 quality measures for diabetes, asthma, and preventive care; utilization of hospital, emergency department, and ambulatory care; standardized costs of care. Pilot practices successfully achieved NCQA recognition and adopted new structural capabilities such as registries to identify patients overdue for chronic disease services. Pilot participation was associated with statistically significantly greater performance improvement, relative to comparison practices, on 1 of 11 investigated quality measures: nephropathy screening in diabetes (adjusted performance of 82.7% vs 71.7% by year 3, P < .001). Pilot participation was not associated with statistically significant changes in utilization or costs of care. Pilot practices accumulated average bonuses of $92,000 per primary care physician during the 3-year intervention. A multipayer medical home pilot, in which participating practices adopted new structural capabilities and received NCQA certification, was associated with limited improvements in quality and was not associated with reductions in utilization of hospital, emergency department, or ambulatory care services or total costs over 3 years. These findings suggest that medical home interventions may need further refinement.
    JAMA The Journal of the American Medical Association 02/2014; 311(8):815-25. DOI:10.1001/jama.2014.353 · 29.98 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The primary objective of this study was to assess the impact of pediatric pain-related conditions on healthcare expenditures. We analyzed data from a nationally representative sample of 6-17 year old children captured in the 2007 National Health Interview Survey and 2008 Medical Expenditure Panel Survey. Healthcare expenditures of children with pain-related conditions were compared to children without pain-related conditions. Pain-related conditions was associated with incremental healthcare expenditures of $1,339 (95% CI $248-$2,447) per capita. Extrapolated to the nation, pediatric pain-related conditions was associated with $11.8 billion (95% CI $2.18 - $21.5 billion) in total incremental healthcare expenditures. The incremental healthcare expenditures associated with pediatric pain-related conditions was similar to those of attention deficit and hyperactivity disorder (ADHD) ($9,23 billion; 95% CI $1,89-$18,1 billion), but more than those associated with asthma ($5.35 billion; 95% CI $0-$12,3 billion) and obesity ($0,73 billion; 95% CI $-6,28- $8,81 billion). Healthcare expenditures for pediatric pain-related conditions exert a considerable economic burden on society. Efforts to prevent and treat pediatric pain-related conditions are urgently needed.
    Pain 02/2015; DOI:10.1097/j.pain.0000000000000137 · 5.64 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Children with developmental disabilities (DDs) have higher rates of emergency department use (EDU) than their typically developing peers do. This study sought to elucidate the relationship between EDU frequency and access to a comprehensive medical home for children with DD.
    Pediatric Emergency Care 07/2014; DOI:10.1097/PEC.0000000000000184 · 0.92 Impact Factor

Full-text (2 Sources)

Available from
May 19, 2014